Implementers' Perspectives of Effects of Free Medical Programme on Service Delivery in Rivers State

Abstract

User fees which came into force in 1980' s courtesy of IMF and World bank are charges made in order to access health with the aim of providing extra funding for a more sustainable health service but with the attendant effect of excluding the poor that ironically has more need for health. It is in the light of this reality that the Rivers State government took a decisive action by abolishing user fees in all public health facilities in January 2012. In this study, attempt has being made to assess the implementers' perspectives on effects of free medical programme on service delivery. Stratified and simple random sampling techniques were used in selecting participants. Study participants were drawn from the core professional groups across various levels of health care delivery in both urban and rural areas of the state. Data tools are self administered questionnaire, key informant interview guide and secondary data instrument (on hospital attendance and drug supply). Data was analysed using the Descriptive statistic tool of SPSS and Microsoft Excel. Frequency distribution tables, bar charts, line graphs and cross tabulations were used to present the results. Over 72% of the respondents were not part of FMP policy formulation and patients' visit to hospital has increased by over 20% in most of the facilities constituting mostly the poor masses. However, there is no commensurate improvement in health care funding, work environment! essential supplies, staff strength and welfare of workers. Majority of th e respondents were of the opinion that integrating FMP with NHIS will make it more sustainable. It is obvious that free medical programme is reaching its target population- the poor masses since most of the patients are of low socioeconomic status. Having removed the demand side barrier through user fee abolition, it is necessary for govemment to address the supply side obstacle s such as poor funding, staff and drugs inadequacy , scarcity of essential hospital consumables, workers' welfare issues and infrastructural problems for a more qualitative and reliable scheme. It is also pertinent for Govemment to collaborate with private sector and development partners in setting up the needed policy and institutional framework for a more sustainable programme while making effort towards integrating the scheme with NHIS to avert the problem o f political interference at the expiration of the current dispensation.